Robert Thiel, Ph.D., Naturopath, Director of Research, Center for Natural Health Research

Key words: attention deficit disorder, ADD, ADHD, nutrition, reflex nutrition assessment

Thiel, R.J. Nutrition-Based Interventions for Attention-Deficit Disorder and Attention-Deficit Hyperactive Disorder. ANMA Monitor 1 (3):5-8 1997
Thiel, R.J. Nutrition-Based Interventions for Attention-Deficit Disorder and Attention-Deficit Hyperactive Disorder. Townsend Letter, April 2000

Abstract: The purpose of this preliminary study was to determine how often nutrition-based interventions could result in behavioral improvement for children and adults with attention-deficit disorder and/or attention-deficit hyperactive disorder. 100.0% who followed the recommendations reported behavioral improvement within 40 days. The 33 participants were given nutritional supplementation, the significance of the results were P < .0001. Food intolerances were found in 90.9% of participants.

INTRODUCTION
Millions of children and adults have attention deficit disorder (ADD) and/or attention deficit hyperactive disorder (ADHD) (sometimes known as hyperkinesis) [1]. ADD is characterized by difficult concentration, a tendency towards distraction, and impaired visual/spacial coordination [2]. ADHD is characterized by inattentiveness, impulsiveness, and hyperactivity: it is the most common neurobehavioral disorder found in children [3]. Males are affected more often than females, and it is estimated that between 1-15% of children suffer from them [4]. Although the causes are not clear, genetics, food additives, nutrition, infections, and abnormalities related to neurotransmitters and the central nervous system are suspected [3,5]. ADD and ADHD are often difficult to differentiate from other disruptive behaviors [6]. Though in some ways similar to major depression, bipolar disorder, and generalized
anxiety disorder [7], ADD and ADHD to some degree have become the diagnoses of choice. ADD and ADHD are often incorrectly diagnosed by school teachers (based on their perception of behavior) [5] and sometimes even pediatricians who occasionally improperly use Ritalin as a diagnostic tool [8].

Most standard interventions rely on stimulant drugs and psychological counseling [9]. The heavy reliance on drugs has resulted in a near drug epidemic: the number of prescriptions for the main stimulants used for people with ADD/ADHD (Ritalin, Dexedrine, and Cylert) tripled from 1990-1994 [1]. Ritalin is a form of speed which many experts feel should be used less frequently [1,5,8]. It should be noted that even many people without ADD/ADHD show greater focus when taking Ritalin [8] and around 20-25% of people with ADHD show no response to it [9].

This report includes the results of a pretest-posttest trial involving 33 people who suffered from ADD, ADHD, or related disorders. The purpose of this trial was to measure how often nutrition-based recommendations could help improve behavior associated with these conditions and to identify dietary factors that may be involved. It did not attempt to address counseling, medical, or other non-nutritional interventions.

SELECTION CRITERIA
Participants were eligible for inclusion in this trial if they resided in California, came to our office, agreed to provide (and did provide) feedback, signed a consent agreement, and indicated that they suffered from ADD, ADHD, or related disorders. This report includes every client who met these criteria during the time period of this study.

36 people were eligible, but three failed to follow the recommendations and/or provide the required feedback. Of the 33 actual participants, the ages of the participants ranged from 2-58; the mean age was 13.1 years. 19 of the participants were male and 14 were female.

METHOD
After completing the selection documentation, all subjects were interviewed for approximately 45 minutes. All subjects were then assessed using Reflex Nutrition Assessment (RNA). RNA is a non-invasive technique used to assess nutrition status by observing the response of muscles under externally provided human-force (it is similar to other forms of muscle testing [10]). Performing RNA for people with ADD/ADHD normally consists of performing three assessments. The first assessment is to determine if a reflex indicates a nutritional need (by observing a reduction in muscular strength); the second is to determine which nutritional intervention can help fit that need (by observing an increase in muscular strength). The third is to assess for possible food intolerances--a weakness when exposed to the food is considered an indication of a possible intolerance. Many have reported success in using RNA or
similar techniques [10-12].

Participants who appeared to have (through the interview process combined with reflex assessment) a sensitivity to one or more foods were advised to discontinue consumption of them. Participants were also advised to consume an average of three tablets per day of one or more nutritional supplements for each related reflex concern (younger children generally took less supplements). Although the actual supplements varied, bovine thyroid and/or herbs were used thyroid reflex concerns (located above the thyroid); calcium and other substances were used for calcium reflex concerns (located above the parathyroid glands); glandulars, herbs and/or amino acids were used for mental fatigue reflex concerns (located approximately three inches above the eye); chromium GTF (sometimes with B vitamins) ws used for pancreatic reflex concerns (located above the pancreas); and different herbs and/or glandulars were used for various infectious concerns (located above the lower colon, naval, and collar-bone.

Subjects were interviewed at approximately 20 day intervals to determine any change in behavior.

RESULTS
51.5% of participants appeared to need calcium support, 48.4% nutritional mental fatigue support (other than calcium or thyroid), 45.2% nutritional thyroid support, 29.0% nutritional infection support, 9.7% nutritional pancreatic support and 16.1% other (mainly b-vitamins or iron). Approximately 20% of participants had been taking Ritalin or some prescription for their ADD/ADHD; all either reduced or eliminated taking these medications, yet reported improvement. Including the food sensitivity assessment, the average participant had 2.9 reflex concerns.

100.0% of participants (or their parents) reported behavioral improvement within 40 days; the P value of this result was < 0.0001. Age and gender did not appear to play any role in determining improvement.

Possible food intolerances were found in 28 (90.3%) of the participants; many had multiple intolerances. Those foods by occurrence were bovine dairy products 41.9%, food colors/preservatives 22.6%, refined carbohydrates (sucrose, white sugar, white rice, white flour) 19.4%, wheat (whole and white) 19.4%, and caffeine containing products 9.7%. One participant each was bothered by apricots, black pepper, brown rice, chocolate, citrus, millet, and oats.

DISCUSSION
The fact that 51.5% of participants appeared to need calcium is consistent with the findings of a panel convened by the National Institutes of Health which found 1/2 of American diets were deficient in calcium [13]. Dr. Sheldon Hendlor has written that calcium can function as a natural tranquilizer, calm nerves, and relieve cramps in legs [14]. This researcher's experience is that children who do not consume dairy products or who are unknowingly sensitive (or allergic) to bovine dairy products are at risk for developing at least mild ADD (non-bovine dairy sources of calcium include goats' milk, bok choy cabbage, turnip greens, spinach, sardines, and broccoli [15]). Since calcium is needed for the neuromuscular system [16], it is no wonder that children with deficiencies demonstrate so-called behavioral problems. Regarding supplementation, typical multi-formulas did not appear to be adequate of themselves (not enough calcium appeared available for absorption).

Nutritional mental fatigue support has been found to be helpful by others. Dr. Steve Nugent has found that substances contained within herbs, as well as gamma-amino butyric acid (GABA) and vitamin B-6 are effective for people with ADD and ADHD [5]. Interestingly, males with primary unipolar depressive disorders have been reported to have significantly less plasma GABA than others [17]; this researcher considers low plasma GABA levels to be a predisposing factor for mood disorders such as ADHD. Dr. Nugent also found what this researcher has found: the highly touted proanthocyandins, often marketed as "pycnogenols", do not on their own appear to be effective for ADD/ADHD [5]. However, when combined with flaxseeds and vitamin B-6, this researcher has found this combination to be helpful for ADD/ADHD. Flaxseeds contain essential unsaturated fatty acids omega 3 and omega 6 [18]. It has been observed that hyperactive children (especially males) may have deficiencies in essential fatty acids (EFAs) due to problems metabolizing linoleic acid or because they may have a greater than normal need for it [19]. An experimental study with supplemental EFAs confirmed this [19]. A study involving 96 boys with behavior and learning problems found that they had below normal plasma levels of omega-3 and omega-6 fatty acids [20]; there were greater behaviorial problems in the boys with the lowest omega-3 concentrations and a greater use of antibiotics in boys with the lowest omega-6 concentrations [20]. Flaxseeds also supply substances essential for the enzyme activity of the brain [5]. Julian Whitaker (MD) who once advocated consumption of flaxseed oil, now instead recommends consumption of whole flaxseeds for general well being [21]. Another useful nutrient, vitamin B-6, is involved in gluconeogenesis, niacin formation, erythrocyte metabolism, hormone modulation, and nervous system function [22]. One researcher found that overactive children with low serotonin levels did better on oral vitamin B6 than they did on Ritalin [23]. Low serotonin levels are often found in children with hyperkinesis [23].

The relatively high incidence of thyroid involvement in this preliminary study was not a surprise. It is consistent with some of this researcher's other work [24] as well as that of headache researcher Dr. Cass Igram. Dr. Igram's clinical experience suggests that, due to dietary habits and food processing techniques, every American will suffer from low thyroid function at some time [25]. He (as well as this researcher and others [26]) has found this will not often be correlated with a medical blood test for hypothyroidism; he and this researcher have found that bovine glandular supplementation is helpful when this problem is encountered [25]. This researcher's clinical experience suggests that flaxseeds can also be helpful for people with thyroid nutritional concerns. This can especially be helpful when dealing with vegetarians. It should be noted that certain medically-oriented researchers tend to feel that thyroid involvement in ADD/ADHD is rare and that it occurs as the result of the body being resistant to thyroxine as opposed to an inability to produce it [27]. While this resistance to thyroxine is correct for a small portion of the population, the results of this study seem to suggest (at least from a nutritional point of view) that thyroid involvement is not rare for people with ADD/ADHD.

Participants with pancreatic reflex concerns were the ones most frequently bothered by sugar. Chromium supplementation has been used by others when hypoglycemia was suspected [28] (which it was for 9.7% of the participants); in this study chromium GTF was combined with B vitamins and other synergists. Lower glycemic diets consisting of more whole grains, certain fruits, vegetables, proteins, and fats and less sugar and refined carbohydrates [29] were recommended to this group along with supplementation. Dr. Carlton Fredericks found that low blood sugar and food sensitivities were often involved with hyperactive children [30].

Sensitivities to foods were commonly found in this study at a rate (90.3%) which greatly exceeds that found by most medically-oriented researchers [4]. This may be because most people with ADD/ADHD probably do not have class I food allergies (were IgE is raised). Dr. Nugent's work appears to correlate with mine in this area: he has found the incidence of dietary involvement in people with ADD/ADHD greatly exceeds that which is stated by the American Pyschiatric Association [5].

Notice this study found twelve different foods/food groups which were involved and that none of the items appeared to universally affect people with ADD/ADHD. It is this individualization which is hard for many to accept. Since virtually no one needs food colors/preservatives, excess refined carbohydrates, and caffeine-containing items, it is not unreasonable for people with ADD/ADHD to avoid them when possible; beyond that, they should seek professional assistance from practitioners properly trained to look for specific food intolerances.

While this researcher will acknowledge that critics will disapprove of the use of individualization techniques such as RNA [31], it appears that the critics have not attained the high success rates that RNA has accomplished for people with ADD/ADHD or even other common problems (i.e., 99.01% for chronic fatigue [24]; 98.8% for musculoskeletal pain relief [32]). This preliminary study demonstrates that individualized nutritional interventions, including selected food avoidance, can be effective in improving behavior for people with ADD, ADHD, or similar disorders. It is hoped that practitioners of all types will look more towards individualized interventions to help those who suffer with these concerns.

REFERENCES
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[31] Kenny, James J., Clemens, Roger, and Forsythe, Kenneth D. Applied kinesiology unreliable for assessing nutrient status. Journal of the American Dietetic Association, Vol. 88, No. 6, June 1988
[32] Thiel R.J. Musculoskeletal pain relief for people with arthritis, lupus, and fibromyalgia. ANMA Monitor 1 (1): 8-10, 1997

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Copyright 1999/2000 by Robert Thiel, Ph.D., Naturopath All rights reserved.